術(shù)前胃鏡及活檢證實(shí)胃竇部腺癌【-】1課件

PatientT,Female,45yearsold

胡某,女，45歲Thegastroscopeandbiopsybeforesurgery:gastricsinusadenocarcinoma

術(shù)前胃鏡及活檢證實(shí)胃竇部腺癌Sep.2004receivedradicalresectionofgastriccancer

2004年9月接受了胃癌根治術(shù)PathologicalReport:UlcerativeAdenocarcinoma,lowdifferentiation,invadesserosalayer,adherencewithadjacentpancreas,lymphnodesmetastasis12/16

病理報(bào)告：低分化潰瘍型腺癌，侵犯漿膜層，與胰腺粘連，淋巴結(jié)轉(zhuǎn)移灶12/16Stage:T4N2M0，G3,StageIV分期IV期，T4N2M0，G3PatientCharacteristicsPatientT,Female,45yearsolCompletedchemotherapyregimen(MMC+CF+5-FU)×4cyclesaftersurgery

手術(shù)后完成4個(gè)周期(MMC+CF+5-FU)方案的輔助化療Physicalexaminationatthe6thmonthafterchemotherapyfindstheleft-supraclavicularlymphnodes(size:2cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolved(size:3cmand2.5cm)術(shù)后6個(gè)月復(fù)診時(shí)體檢發(fā)現(xiàn)左側(cè)鎖骨上淋巴結(jié)腫大，2cm。CT掃描發(fā)現(xiàn)腹膜后兩個(gè)腫大淋巴結(jié)，3cm及2.5cmCA199：305u/LCEA:126ng/mlPriorTreatmentCompletedchemotherapyregimenWhat’syourRecommendRegimen?Singleagent?1、Xeloda1250mg/m2,twicedaily,×14days,6cycles

Combinationregimens?2、DF(cisplatin+5-FU)3、Xeloda+cisplatin4、FOLFOX(5-FU/LV+Oxaliplatin) 5、Irinotecan-basedregimen6、Taxane-basedregimen0%0%10.3%41.4%0%48.3%What’syourRecommendRegimen?ActualTreatmentPatientreceivedXeloda+cisplatinregimenasfirst-linechemotherapyXeloda:1000mg/m2,twicedaily,×14dayscisplatin:75mg/m2,day1every3weeks

Patientcomplainedthattheadversereactionofnauseandvomitingofcisplatinwastoopainfulforhertogoonwithmoretreatment.Onlycompleted2cycles.

患者由于順鉑所致的惡心嘔吐反應(yīng)過(guò)重，只進(jìn)行了兩個(gè)周期的化療。ActualTreatmentPatientrecePhysicalexamination:left-supraclavicularlymphnodes(size:1cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolvedshrinkobviously,(size:2cmand1cm)CA199:102u/LCEA:21ng/mlPartialResponseActualResponsePhysicalexamination:left-sup1、MaintainXelodaandcisplatindosage?因原方案有效維持原方案化療？2、Reducecisplatindosageto75%

andcontinue?將順鉑劑量減為原劑量的75%后繼續(xù)治療？3、Interrupt？中斷治療4、Changedrug？更換藥物Whattodonext?6.3%40.6%0%53.1%1、MaintainXelodaandcisplatChangedrugPatientreceivedXELOXXeloda:1000mg/m2,twicedaily,×14daysOxaliplatin:130mg/m2,day1every3weeksCompleted4cyclesActualTreatmentChangedrugActualTreatmentThemildsymptomsoferythemaandswellingonherhandsandfeetwerebeobservedafter2cyclesofXELOX.Shecontinuedtheother2cyclesofXELOXwithoutdosagereducingortreatmentdelaying.完成2周期后患者有輕微的手足部痛性紅斑及腫脹。但這并沒(méi)有促使化療減量或延期。Insensiblefeelingofhandsandfeetcausedbyoxaliplatinalsohappened.Butmildtoo.

奧沙利鉑導(dǎo)致的手足麻木感也很輕微。

AdverseReactionThemildsymptomsoferythemaPhysicalexamination:left-supraclavicularlymphnodes(size:0.5cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolveddisappeared,(size:0cmand0cm)CA199:40u/LCEA:11ng/mlPartialResponseActualResponsePhysicalexamination:left-supWhatshallyoudoafter6cycles?Maintaintherapy?1、Xeloda1000mg/m2,twicedaily,×14daysContinuewithXELOX

2、Xeloda+OxaliplatinChangetootherregimen?3、T+F(5-FU/LV+Taxane)4、FOLIRI(5-FU/LV+Irinotecan)5、Radiotherapy?6、Observe?37.5%21.9%3.1%9.4%6.3%21.9%Whatshallyoudoafter6cyclPatientreceivedpalliativeradiotherapytheleft-supraclaviculararea:50GYtheareaoftumorbed:45GY

患者接受了姑息性放療，左側(cè)鎖骨上區(qū)域50GY，原瘤床部位45GYConcurrentchemotherapyXeloda900mg/m2,twicedaily,×14days2cycles

希羅達(dá)同步增敏化療2周期ActualTreatmentPatientreceivedpalliativeraClinicalEfficacyPhysicalexamination:left-supraclavicularlymphnodesdisappeared.CTScan:twolymphnodesbehindposteriorperitoneuminvolveddisappearedCA199:12u/LCEA:6ng/mlCompleteResponseLastfollowupdate:Apr.2006ClinicalEfficacyPhysicalexamWhatshallyoudonext?1、Xeloda1000mg/m2,twicedaily,×14days2、Xeloda(5FU)+Oxaliplatin3、otherregimens

4、Observe?24.2%0%0%75.8%Whatshallyoudonext?1、Xelod+)*&$#ZXVTSQONLJIGEDBzywutrpomkihfdca875320-)*%$#YXVTSQOMLJHGECBzxwusrpnmkihfdba865310-(*%!#YWVTRQOMLJHFECAzxvusqpnlkigfdba86431+-(&%!ZYWUTRPOMKJHFDCAyxvtsqonljigedb986431+)(&$!ZXWUSRPNMKIHFDCAywvtrqomljhgecb976421+)*&$#ZXVUSQPNLKIGFDBAywvtrpomkjhfeca975420+)*&$#YXVTSQONLJIGEDBzywutrpnmkihfdca875320-)*%$#YXVTRQOMLJHGECBzxwusrpnmkigfdba865310-(*%!#YWVTRQOMKJHFECAzxvusqpnlkigfdb986431+-(&%!ZYWUTRPOMKIHFDCAyxvtsqonljigedb986421+)(&$!ZXWUSRPNMKIHFDBAywvtrqomljhgecb976420+)*&$#ZXVUSQPNLKIGFDBAywutrpomkjhfeca975420+)*%$#YXVTSQONLJIGEDBzywusrpnmkihfdca875320-)*%$#YWVTRQOMLJHGECBzxwusrpnlkigfdba865310-(*%!#YWVTRPOMKJHFECAzxvusqpnlkigedb986431+-(&%!ZYWUTRPNMKIHFDCAyxvtsqonljigedb976421+)(&$!ZXWUSRPNMKIGFDBAywvtrqomljhgecb975420+)*&$#ZXVUSQPNLKIGFDBzywutrpomkjhfecaca875320-)*%$#YXVTSQOMLJHGECBzxwusrpnmkihfdba865310-(*%!#YWVTRQOMLJHFECAzxvusqpnlkigfdba86431+-(&%!ZYWUTRPOMKJHFECAyxvtsqonljigedb986431+)(&$!ZXWUSRPNMKIHFDCAywvtrqomljhgecb976421+)(&$#ZXVUSQPNLKIGFDBAywvtrpomkjhfeca975420+)*&$#YXVTSQONLJIGEDBzywutrpomkihfdca875320-)*%$#YXVTRQOMLJHGECBzxwusrpnmkigfdba865310-(*%!#YWVTRQOMKJHFECAzxvusqpnlkigfdb986431+-(&%!ZYWUTRPOMKJHFDCAyxvtsqonljigedb986421+)(&$!ZXWUSRPNMKIHFDBAywvtrqomljhgecb976421+)*&$#ZXVUSQPNLKIGFDBAywutrpomkjhfeca975420+)*%$#YXVTSQONLJIGEDBzywutrpnmkihfdca875320-)*%$#YWVTRQOMLJHGECBzxwusrpnlkigfdba865310-(*%!#YWVTRPOMKJHFECAzxvusqpnlkigedb986431+-(&%!ZYWUTRPNMKIHFDCAyxvtsqonljigedb976421+)(&$!ZXWUSRPNMKIGFDBAywvtrqomljhgecb976420+)*&$#ZXVUSQPNLKIGFDBzywutrpomkjhfeca975420-)*%$#YXVTSQONLJIGEDBzywusrpnmkihfdca875320-)*%!#YWVTRQOMLJHGECBzxwusqpnlkigfdba865310-(*%!#YWUTRPOMKJHFECAzxvusqpnljigedb986431+-(&%!ZYWUSRPNMKIHFDCAyxvtsqonljigecb976421+)(&$!ZXWUSRPNLKLKIGFDBAywvtrpomkjhfeca975420+)*&$#ZXVTSQONLJIGEDBzywutrpomkihfdca875320-)*%$#YXVTRQOMLJHGECBzxwusrpnmkihfdba865310-(*%!#YWVTRQOMKJHFECAzxvusqpnlkigfdb986431+-(&%!ZYWUTRPOMKJHFDCAyxvtsqonljigedb986421+)(&$!ZXWUSRPNMKIHFDBAywvtrqomljhgecb976421+)*&$#ZXVUSQPNLKIGFDBAywutrpomkjhfeca975420+)*&$#YXVTSQONLJIGEDBzywutrpnmkihfdca875320-)*%$#YWVTRQOMLJHGECBzxwusrpnmkigfdba865310-(*%!#YWVTRPOMKJHFECAzxvusqpnlkigedb986431+-(&%!ZYWUTRPOMKIHFDCAyxvtsqonljigedb976421+)(&$!ZXWUSRPNMKIGFDBAywvtrqomljhgecb976420+)*&$#ZXVUSQPNLKIGFDBzywutrpomkjhfeca975420+)*%$#YXVTSQONLJIGEDBzywusrpnmkihfdca875320-)*%!#YWVTRQOMLJHGECBzxwusrpnlkigfdba865310-(*%!#YWUTRPOMKJHFECAzxvusqpnljigedb986431+-(&%!ZYWUTRPNPNMKIHFDCAyxvtrqomljhgecb976421+)(&$#ZXVUSQPNLKIGFDBAywvtrpomkjhfeca975420+)*&$#ZXVTSQONLJIGEDBzywutrpomkihfdca875320-)*%$#YXVTRQOMLJHGECBzxwusrpnmkihfdba865310-(*%!#YWVTRQOMKJHFECAzxvusqpnlkigfdba86431+-(&%!ZYWUTRPOMKJHFDCAyxvtsqonljigedb986421+)(&$!ZXWUSRPNMKIHFDCAywvtrqomljhgecb976421+)*&$#ZXVUSQPNLKIGFDBAywutrpomkjhfeca975420+)*&$#YXVTSQONLJIGEDBzywutrpnmkihfdca875320-)*%$#YWVTRQOMLJHGECBzxwusrpnmkigfdba865310-(*%!#YWVTRPOMKJHFECAzxvusqpnlkigfdb986431+-(&%!ZYWUTRPOMKIHFDCAyxvtsqonljigedb976421+)(&$!ZXWUSRPNMKIHFDBAywvtrqomljhgecb976420+)*&$#ZXVUSQPNLKIGFDBzywutrpomkjhfeca975420+)*%$#YXVTSQONLJIGEDBzywusrpnmkmkihfdca865310-(*%!#YWVTRQOMLJHFECAzxvusqpnlkigfdba86531+-(&%!ZYWUTRPOMKJHFECAyxvtsqonljigedb986431+-(&$!ZXWUSRPNMKIHFDCAyxvtrqomljhgecb976421+)(&$#ZXVUSQPNLKIGFDBAywvtrqomkjhfeca975420+)*&$#ZXVTSQONLJIGEDBzywutrpomkihfdca875320-)*%$#YXVTSQOMLJHGECBzxwusrpnmkihfdba865310-(*%!#YWVTRQOMKJHFECAzxvusqpnlkigfdba86431+-(&%!ZYWUTRPOMKJHFDCAyxvtsqonljigedb986431+)(&$!ZXWUSRPNMKIHFDCAywvtrqomljhgecb976421+)*&$#ZXVUSQPNLKIGFDBAywvtrpomkjhfeca975420+)*&$#YXVTSQONLJIGEDBzywutrpnmkihfdca875320-)*%$#YXVTRQOMLJHGECBzxwusrpnmkigfdba86565310-(&%!ZYWUTRPOMKJHFECAzxvtsqonljigedb986431+-(&%!ZXWUSRPNMKIHFDCAyxvtsqomljhgecb976421+)(&$!ZXWUSQPNLKIGFDBAywvtrqomljhfeca975420+)*&$#ZXVUSQONLJIGEDBzywutrpomkjhfeca875320-)*%$#YXVTSQONLJHGECBzxwusrpnmkihfdca865310-(*%!#YWVTRQOMLJHGECAzxvusqpnlkigfdba86531+-(&%!ZYWUTRPOMKJHFECAyxvtsqonljigedb986431+-(&$!ZXWUSRPNMKIHFDCAyxvtrqomljhgecb976421+)(&$#ZXVUSQPNLKIGFDBAywvtrqomkjhfeca975420+)*&$#ZXVTSQONLJIGEDBzywutrpomkjhfdca875320-)*%$#YXVTSQOMLJHGECBzxwusrpnmkihfdba865310-(*%!#YWVTRQOMLJHFECAzxvusqpnlkigfdba86431+-(&%!ZYWUTRPOMKJHIHFDCAyxvtsqonljhgecb976421+)(&$!ZXWUSRPNLKIGFDBAywv